Physician Practices With Robust Capabilities Spend Less On Medicare Beneficiaries Than More Limited Practices

Abstract

No research has considered a range of physician practice capabilities for managing patient care when examining practice-level influences on quality of care, utilization, and spending. Using data from the 2017 National Survey of Healthcare Organizations and Systems linked to 2017 Medicare fee-for-service claims data from attributed beneficiaries, we examined the association of practice-level capabilities with process measures of quality, utilization, and spending. In propensity score-weighted mixed-effects regression analyses, physician practice locations with "robust" capabilities had lower total spending compared to locations with "mixed" or "limited" capabilities. Quality and utilization, however, did not differ by practice-level capabilities. Physician practice locations with robust capabilities spend less on Medicare fee-for-service beneficiaries but deliver quality of care that is comparable to the quality delivered in locations with low or mixed capabilities. Reforms beyond those targeting practice capabilities, including multipayer alignment and payment reform, may be needed to support larger performance advantages for practices with robust capabilities.

Exhibit 4

Adjusted total spending by physician practice location capability levels Source/Notes: SOURCE Authors’ analysis of claims data of 2017 Medicare fee-for-service beneficiaries, 2017–18 National Survey of Healthcare Organizations and Systems, and the 2016 IQVIA OneKey Database. NOTE Physician practice locations with mixed or limited capabilities had significantly higher spending compared with physician practice locations with robust capabilities (p < 0.001).